Effect of Tirofiban on Cognitive Function in Patients With Unruptured Intracranial Aneurysms After Endovascular Embolization.

Abstract

Aims/Background An unruptured intracranial aneurysm (UIA) is a cerebrovascular disease with a potential risk of rupture. Rupture of UIA is a leading cause of spontaneous subarachnoid hemorrhage, which carries a high mortality rate. While endovascular intervention emerged as the primary treatment option for UIA, postoperative cognitive dysfunction (POCD) remains a common complication, affecting patients' postoperative recovery. Therefore, identifying effective interventions is clinically crucial for improving postoperative cognitive function. Tirofiban, an antiplatelet agent, has shown potential neuroprotective effects in neurointerventional procedures. Hence, this study aims to evaluate the effect of tirofiban on postoperative cognitive function in patients with UIA. Methods This retrospective study analyzed 125 UIA patients who underwent treatment between January 2021 and December 2024. All patients underwent simple coil embolization and were divided into two groups: an observation group (treated with tirofiban) and a control group (without tirofiban). Before surgery, these patients were routinely treated with aspirin and clopidogrel. However, patients in the observation group were given tirofiban in addition to standard care for 12 hours after the procedure. Furthermore, cognitive function was assessed before and after surgery using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores. Additionally, the incidence of postoperative silent cerebral infarction (SCI) and variations in inflammatory marker levels were compared between the two groups. Results Cognitive function showed no significant difference between the two groups before surgery. After the procedure, the observation group demonstrated significantly higher MoCA (p < 0.001) and MMSE (p = 0.001) scores than the control group, indicating a significant advantage of tirofiban in improving cognitive function. Within 72 hours postoperatively, 7 cases in the observation group developed SCI compared to 18 cases in the control group, with a significantly lower incidence of SCI in the observation group (p = 0.025). Preoperative comparison of inflammatory markers revealed no difference between the two groups (p > 0.05). However, their postoperative levels were significantly lower in the observation group (p < 0.05). The cognitive function scores remained significantly higher in the observation group than in the control group over one month follow-up period (p < 0.05). Conclusion Tirofiban improves cognitive function and reduces SCI and inflammation following UIA embolization, possibly via antiplatelet and anti-inflammatory mechanisms. While statistically significant, the clinical relevance of cognitive improvement (1 point) is limited and requires further investigation. Furthermore, prospective randomized trials are needed to validate the long-term efficacy of tirofiban and elucidate underlying mechanisms.